Forefoot pain (metatarsalgia)

Literally, “metatarsalgia” means pain in the metatarsals of the foot, or forefoot pain.

The pain is commonly on the sole of the foot and often sharp, described as similar to walking on pebbles or like having a stone in the shoe. However, there are a variety of possible causes of metatarsalgia and consequently the type of pain described varies also. Some people describe localized pain to one or two toes whilst others describe more generalized pain or burning pain.

Symptoms

The main symptom is that of pain. Sometimes there is associated swelling in the foot although frequently there is none. There may be build up of hard skin over the painful area. This is called a callosity. People usually report more pain when taking weight through the affected foot but sometimes also complain of pain when at rest or in bed at night. Sometimes numbness accompanies pain into the toes. Depending upon the cause, some people might have noticed a problem with the shape of their foot or toes which may also be relevant. Overall, these symptoms can often interfere with comfort in shoes and ability to walk or play sport.

Causes

There are many causes of metatarsalgia and your Choropodist will make a careful assessment to decide upon the correct diagnosis and treatment. Some common causes include:

Problems with the mechanics of the foot (the way body weight is distributed):

Overweight

Overuse (eg sports)

Hallux valgus (bunions)

Hallux rigidus (arthritis of the big toe)

Problems with inflammation in the joints of the forefoot:

Arthritis (various different types can affect the foot)

Gout

Problems with the bones:

Fracture of a metatarsal

“Stress reaction” in a metatarsal (can precede a fracture)

Problems with the nerves: The most common nerve problem is called Morton’s neuroma. This occurs when one or more of the nerves supplying sensation to the toes are squeezed and irritated over a period of time causing scarring of the nerve and in turn more persistent pain in the forefoot (often including a burning pain and feeling of numbness in the affected toes).

Problems with the toes: Deformed toes rubbing in the shoe

Diagnosis

Finding the correct diagnosis and hence cause of the metatarsalgia is essential to being able to advise the correct treatment. Sometimes more than one diagnosis is present.

Our specialist will talk to you to gain clues from the history of your condition and will then examine you. Xrays and other investigations such as magnetic resonance imaging (MRI) may also be required and we will discuss these with you.

Treatment

A ruptured tendon can be treated non-operatively with Plaster of Paris and then “functional” bracing or with surgery. Each method has its advantages and disadvantages.